Patricia C Henwood1,2, David C Mackenzie2,3, Joshua S Rempell1,2, Emily Douglass2, Damas Dukundane2,4, Andrew S Liteplo5, Megan M Leo2,6, Alice F Murray2,6, Samuel Vaillancourt2,7, Anthony J Dean2,8, Resa E Lewiss2,9, Stephen Rulisa4, Elizabeth Krebs10, A K Raja Rao2, Emmanuel Rudakemwa11, Vincent Rusanganwa12, Patrick Kyanmanywa13, Vicki E Noble2,5. 1. Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA. 2. Point-of-Care Ultrasound in Resource Limited Environments, Boston, MA, USA. 3. Department of Emergency Medicine, Maine Medical Center, Portland, OR, USA. 4. University Teaching Hospital of Kigali, Kigali, Rwanda. 5. Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA. 6. Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA. 7. Department of Emergency Medicine, St. Michael's Hospital, Toronto, Canada. 8. Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA. 9. Department of Emergency Medicine, University of Colorado, Denver, CO, USA. 10. Department of Emergency Medicine, Duke University Medical Center, Durham, NC, USA. 11. King Faisal Specialist Hospital, Kigali, Rwanda. 12. Ministry of Health, Kigali, Rwanda. 13. University of Rwanda, Butare, Rwanda.
Abstract
OBJECTIVE: We delivered a point-of-care ultrasound training programme in a resource-limited setting in Rwanda, and sought to determine participants' knowledge and skill retention. We also measured trainees' assessment of the usefulness of ultrasound in clinical practice. METHODS: This was a prospective cohort study of 17 Rwandan physicians participating in a point-of-care ultrasound training programme. The follow-up period was 1 year. Participants completed a 10-day ultrasound course, with follow-up training delivered over the subsequent 12 months. Trainee knowledge acquisition and skill retention were assessed via observed structured clinical examinations (OSCEs) administered at six points during the study, and an image-based assessment completed at three points. RESULTS: Trainees reported minimal structured ultrasound education and little confidence using point-of-care ultrasound before the training. Mean scores on the image-based assessment increased from 36.9% (95% CI 32-41.8%) before the initial 10-day training to 74.3% afterwards (95% CI 69.4-79.2; P < 0.001). The mean score on the initial OSCE after the introductory course was 81.7% (95% CI 78-85.4%). The mean OSCE performance at each subsequent evaluation was at least 75%, and the mean OSCE score at the 58-week follow up was 84.9% (95% CI 80.9-88.9%). CONCLUSIONS: Physicians providing acute care in a resource-limited setting demonstrated sustained improvement in their ultrasound knowledge and skill 1 year after completing a clinical ultrasound training programme. They also reported improvements in their ability to provide patient care and in job satisfaction.
OBJECTIVE: We delivered a point-of-care ultrasound training programme in a resource-limited setting in Rwanda, and sought to determine participants' knowledge and skill retention. We also measured trainees' assessment of the usefulness of ultrasound in clinical practice. METHODS: This was a prospective cohort study of 17 Rwandan physicians participating in a point-of-care ultrasound training programme. The follow-up period was 1 year. Participants completed a 10-day ultrasound course, with follow-up training delivered over the subsequent 12 months. Trainee knowledge acquisition and skill retention were assessed via observed structured clinical examinations (OSCEs) administered at six points during the study, and an image-based assessment completed at three points. RESULTS: Trainees reported minimal structured ultrasound education and little confidence using point-of-care ultrasound before the training. Mean scores on the image-based assessment increased from 36.9% (95% CI 32-41.8%) before the initial 10-day training to 74.3% afterwards (95% CI 69.4-79.2; P < 0.001). The mean score on the initial OSCE after the introductory course was 81.7% (95% CI 78-85.4%). The mean OSCE performance at each subsequent evaluation was at least 75%, and the mean OSCE score at the 58-week follow up was 84.9% (95% CI 80.9-88.9%). CONCLUSIONS: Physicians providing acute care in a resource-limited setting demonstrated sustained improvement in their ultrasound knowledge and skill 1 year after completing a clinical ultrasound training programme. They also reported improvements in their ability to provide patient care and in job satisfaction.
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